What are some of the challenges for producing thicker foodstuffs for patients with dysphagia? Providing special food products that are easy to swallow, and also meet nutritional requirements is a challenge for food rheologists and healthcare staff. If you missed our session at the 9th Korean Dysphagia Society Regular Academic Conference, you can learn more about the role of hydrocolloids, presented by Graham Sworn, PhD, Technical Fellow, DuPont Nutrition & Health in this presentation.

1. D u P o n t ™ D a n i s c o ®
MAY 26, 2018
The Role of
Hydrocolloids in
the Management
of Dysphagia
Special Lecture –
The Korean Dysphagia
Society
Graham SWORN, Ph.D
Technical Fellow, DuPont Nutrition & Health

2. D u P o n t ™ D a n i s c o ®
Management of Dysphagia
Speed of the flow of bolus too fast for closure of epiglotis.
음식물의 유속이 후두개가 닫히는 속도보다 빠를 경우 호흡장애의 위험이 높아진다.
2
Product Velocity in pharynx Aspiration risk
Water 0.5 ms-1 High
Yogurt 0.2 ms-1 Low
Hasegawa et al. (2005). Nihon Shokuhin
Kagaku Kogaku Kaishi, 52, 441-447.
Hasegawa et al.,(2008). Nihon Shokuhin
Kagaku Kogaku Kaishi, 55, 330-337.
Strategies
Careful selection of foods with the right consistency for the specific patient.
환자에 맞춘 올바른 점도를 가진 식품을 주의해서 선택해야 한다
Physical modification of foods to provide the right consistency for the specific patient
식품의 물리적 성질의 변화시켜 환자에게 적합한 점도를 맞출 수 있다
Ready-to-eat foods specific for dysphagia
삼킴장애환자에게 적합한 즉석식품도 대안이 될 수 있다
Powder thickeners for modifying the consistency beverages
특히 음료의 점도는 분말형태의 점도증진제로 맞출 수 있다

3. D u P o n t ™ D a n i s c o ®
Products for the management of dysphagia
3
Powder thickeners RTE products

4. D u P o n t ™ D a n i s c o ®
Hydro = water loving 친수성
Colloid = substance (1nm – 1μm) microscopically dispersed
evenly throughout another substance
Colloid = 다른 물질을(물)내에 현미경적으로 매우 고르게
분산될 수 있는 작은(1nm~1um) 물질
A hydrocolloid is simply a system wherein the colloidal
particles are dispersed in water
즉, Hydrocolloid 는 물에 분산되는 콜로이드성 입자들로
이루어진 system 입니다
The colloidal particle binds water by hydrogen bonds
이 콜로이드 입자는 수소결합에 의해 물분자와 결합합니다
Hydrocolloids have the ability to go from a nearly soluble form
to a nearly insoluble form by addition of sugar, salts or acid
Hydrocolloids는 당류,염,산의 첨가에 의해 수용성 형태에서
불용성 형태로 변화될 수 있는 성질을 가지고 있습니다
Many are high molecular weight polysaccharides
대부분이 분자량이 큰, 다당류입니다
4
What is a hydrocolloid?

5. D u P o n t ™ D a n i s c o ®
Main hydrocolloid functionalities
Function Hydrocolloid
Gelling (겔 형성) Carrageenan, pectin, xanthan/LBG, alginate, gelatin,
gellan
Thickening (증점 효과) LBG, guar, cellulose gum, pectin, alginate, xanthan
Suspension (분산력) Carrageenan, xanthan, pectin, gellan
Cohesion (응집력) Gum arabic, gelatin, starch
Physical stabilisation
(물리적 안정성)
Carrageenan, pectin, xanthan, gum arabic, cellulose
gum
Film formation (피막 형성) Gum arabic, starch, alginate
Mouthfeel (식감) All
Adhesion(접착력) Starch, gum arabic
Bulking agent (증량효과) Starch
Nutritional (영양성분) Starch, guar, pectin
Texturising (조직감) All
5

6. D u P o n t ™ D a n i s c o ®
Selection of gels 겔화제의 선택
Texture 조직감
6
HA gellan gum
Agar
Xanthan/LBG
Pectin
Alginate
LA gellan gum
k-carrageenan
Gelatin
Firm, brittle
Soft, elastic
i-carrageenan

7. D u P o n t ™ D a n i s c o ®
Ideal properties for a thickener for Dysphagia
삼킴장애환자를 위한 이상적인 점도증진제의 특성
Easy dispersion at low mixing speeds
저속의 혼합공정에서도 쉽게 분산
Fast hydration
빠르게 수화
Stable viscosity as a function of: 시간과 온도에서 안정적인 점도
Time
Temperature
Must perform in different media (water, fruit juice, milk etc.)
여러가지 식품형태에서도 작용해야 함
Must perform Hot or Cold
차갑거나 뜨거운 상태에서도 작용해야 함
Commonly used thickeners :
• Modified Starch
• Xanthan gum
• Guar gum
• Cellulose gum

8. D u P o n t ™ D a n i s c o ® 8
How do you define thick?
Concentration Description Viscosity at 50 s-1
(mPa.s)
LST
value
0.5 – 1% Mildly thick 50 – 100 43 – 40
1 – 2% Moderately thick 100 – 400 39 – 33
2 – 3% Extremely thick 400 - 600 32 - 30
Proposed classifications of thickness in Japan
This approach assumes that all thickeners will respond in the same way to the two tests.

9. D u P o n t ™ D a n i s c o ® 9
The International Dysphagia Diet
Standardisation Initiative,
or IDDSI, aims to develop global standardised
terminology and definitions for texture
modified foods and thickened liquids for
individuals with dysphagia of all ages, in all
care settings, and all cultures.
IDDSI (The International Dysphagia Diet
Standardisation Initiative) 는 모든 문화적
차이와 모든 치료방법설정에서 모든 연령대의
삼킴장애환자를 위한 조직변성식품과
증점액의 국제적으로 표준화된 용어와 정의를
개발하는 것을 목표로 하고 있다.
(c) The International Dysphagia Diet Standardisation
Initiative 2016

10. D u P o n t ™ D a n i s c o ®
Recent studies in Japan
삼키기 쉬우려면, 액상식품은 반드시
물성학적으로 “structured fluid”여야 한다.
이 물성학적 특징이, 식품이 하나의
끊어지지 않은 하나의 덩어리(coherent
bolus)로 인두부를 지나가게 하여, 쉽게
삼켜진다는 느낌을 주게 된다.
호흡장애의 위험성은 낮은 shear rates에서
식품의 점도가 감소할 수록 증가하는
것으로 보인다.

11. D u P o n t ™ D a n i s c o ® 11
High shear
Extensional
Linear
viscoelastic
Low shear
Pseudoplastic / Shear thinning
Elastic behavior
Viscosity at
50s-1, LST,
Flow test
Newtonian
Single point viscosity measurements ARE NOT suitable for product characterisation of
non-Newtonian materials.
Single point 점도측정법은 non-Newtonian 물질의 특성을 가진 제품에는 적합하지 않다.
Complex Rheological Behavior: Advantage for Dysphagia?
Building Knowledge:
• Classify extensional behaviors
• 다양한 Extensional 유체 특성 분류
• Identify rates and deformations
relevant to dysphagia
• 연하장애와관련된 shear rate와
유체변형 확인
• Identify behaviors favorable /
unfavorable for Dysphagia
• 삼킴장애환자에 유/불리한
유체특성의 확인

12. D u P o n t ™ D a n i s c o ®
Conclusions
12
Steele et al (2015). The influence of food texture and liquid consistency modification on
swallowing physiology and function: A Systematic Review. Dysphagia, 30, 2–26.
Thicker foods are easier and safer to
swallow
• Thickened liquids provide a benefit
in terms of reducing aspiration, but
it is also associated with a risk of
post-swallow residue in the pharynx
with the thicker consistencies.
(Steele et al. 2015)
The ideal rheological profile for safe
swallowing is not known.
• The ideal properties may vary:
• according to the different stages
of the swallowing process?
• according to the patient?
Further Research
• Need to understand the
significance of the complex
rheology of the thickened liquids to
be able to design the most suitable
products for Dysphagia.
연하환자용 증점식품은 삼키기 쉽고
안전해야 한다
• 증점액은 호흡장에 위험을
감소시켜주는 이점이 있으나
인두부에 남아있는 높은 점성을
가진 잔여물에 의한 위험성과도
연관될 수 있다.. (Steele et al. 2015)
이상적 특징은 아래 조건에 따라 다를
수 있다
• 삼키는 과정의 각 단계
• 환자마다의 특성
향후 과제
• 연하환자용 제품의 가장 적합하게
디자인 될 수 있는 증점액의
복합적인 물성학적 특징에 대한
이해가 필요하다

13. D u P o n t ™ D a n i s c o ®
For more information
13
• Chapter 9. Rheology Modifiers for the
Management of Dysphagia by Graham
Sworn
• Published in Rheology of Biological Soft
Matter, 2017. Springer

14. Thank You
Copyright © 2018 DuPont or its affiliates. All rights reserved.
The DuPont Oval Logo, DuPont™ Danisco® and all products denoted with ™ or ® are registered trademarks or trademarks of E. I. du Pont de Nemours and
Company or its affiliates.
Contact :
한은정 부장, Sales Manager, DuPont Nutrition & Health, Korea
Tel) 02-2222-5288
E-mail) EunJung.Han@dupont.com